Chronic Inflammatory Dermatoses Flashcards
What are the five chronic inflammatory dermatoses we discussed?
- psoriasis
- lichen planus
- systemic lupus erythematosis
- seborrheic dermatitis
- acne vulagris
About psoriasis…
- what’s the prevalence?
- During what generations does it peak?
- What is the genetics behind it?
- about 4%
- 30s and 60a
- presumed autosomal dominance with modifying features and environmental triggers
What are the clinical features of psoriasis?
sharply demarcated erythema usually with a thick micaceous scale
Auspitz sign (you scratch and it bleeds under the surface)
Koebner sign (happens in areas that had previous trauma)
Nail disease is common in up to 50%
Rarely pustular
What is the pathogenesis of psoriasis?
A T-CELL MEDIATED AUTOIMMUNE DISORDER
- envrionmental factor triggers T cells to produce cytokines
- The cytokines stimulate keratinocye proliferation and the production of antigenic adhesion molecules in the dermal blood vessles
- The adhesion molecules further stimulate T cells to produce cytokines
- cycles until you get the rash
What are 5 risk factors associated with psoriasis?
- genetics
- psychological stress
- medications
- infection
- chronic HIV
What are some precipitating agents of psoriasis outbreaks?
infection, trauma, stress, ETOH, systemic steroids (esp on withdrawal), beta blockers, lithium, antimalarials, Indomethacin
What should be in your diagnosis when you see psoriasis. How woul dyou tell for sure?
DD: lichem simplex chronicus, nummular eczema, seborrheic dermatitis, and tinea corporis
You have to use a punch biopsy to be sure.
What are the four types of psoriasis?
- chronic plaque (most common)
- inverse
- guttate
- pustular
Where does the chronic plaque psoriasis occur on the body?
scalp
extensor surfaces like elbow, knees, presacral and nails
palms and soles (esp thick scale of the arch of the foot and thenar hypothenar palms)
Where does inverse psoriasis usually occur on the body?
the intertriginous areas (fold areas) like the gluteal fold, axillae, and glans of the penis
What characteristic of plaque psoriasis is lackin gin inverse psoriasis?
the scale may not appear in the inverse
WHat are the chraacteristics of guttate psoriasis?
eruptive trunkal dermatosis
it’s a sudden onset of tear drop shaped (2 to 5 mm) scaled spots of the tunk and proximal extremities
When does guttate psoriasis almost always occur?
usually childhoold or young adulthoods POST STREP INFECTION
Describe pustular psoriasis?
It starts as small pustules on the palms and soles (pustular psoriasis of barber)
they generalize with fever and can be life threatening
What are complications of psoriasis?
- mental health issues - depression, anxiety, etc.
- increased risk of non-melanoma skin cancers and lmphoma
- psoriatic arthritis
WHat are two nail deformities that are associated with psoriasis?
onycolysis - the separation of the nail plate from the nail bed
pitting of the nail plate itself
In general, what is lichen planus?
a chronic inflammatory autoimmune disease
What is the prevalence of lichen planus and who does it usually effect?
.1 to 4 % of the pop
usually perimenopausal females (30-60)
What virus is lichen planus associated with?
Hep C
Where do lichen planus rashes usually occur?
WRISTS, chins, mucous membranes
What is the clinical hallmark of lichen planus?
Wickham’s striae = whitish lines visible in the stria of papeuls of lichen planus
What are the “6 Ps” of lichen planus?
planar (flat topped)
purple
polygonal (not round)
pruritic
papules
plaque
What are the 6 forms of lichen planus?
linear (classic)
annular
atrophic
jypertrophic
vesiculbullous
erosive/ilcerative
What happens in hypertrophic lichen planus?
you get very thick plaques of scale of the lichen planus, esp over the extremities and extensor surfaces
What happens in bullous lichen planus?
you get blisters occuring under the lichen planus due to the severe interface dermatitis
What does oral lichen planus look like?
It’s tendr red patches on the buccal mucosa with a surface covered in Wickham’s striae - which does NOT wipe off like thrush would.
What is the treatment for lichen planus?
It may resolve sponantouely sin 1-2 years, but often relapses
Use topical or oral steroids
phototherapy
stop the drug is it was drug induced
What are the three forms of systemic lupus erythematosus?
acute
subacute
chronic cutaneous (discoid)
What group of people are at higher risk for systemic lupus erythematosus?
more common in women
most diagnosed between 14-40
more common in african americans, hispanics and asians
What lab tests should you run to check for SLE?
CBC
Sed rate
Kidney/Liver tests
UA
ANA - checking for antinuclear antibody
What are the symptoms of acute lupus erythematosus?
You get an acute photosensitivity pattern of erythema in a butterfly rash across the nose and cheeks
You can also get a red rash of the sun exposed upper chest and extensor areas (may become bulolous here)
Many have non-specific features like digital infarcts/ulcers associated with Raynaud’s Syndrome
What sort of rash forms in subacute cutaneous lupus?
erythematous and usually scaling rash of the upper traunk and extensor surfaces
it looks like a psoriasis plaque ,but it isn’t
It’s due to the SSA or SSB antibody
What happens in chronic cutaneous lupus (discoid)?
You get scarring lesions of the skin (especialy the outer ear)
There are three other rarer forms of SLE called tumid lupus, lupus panniculitis, and verrucous lupus. WHat are their hallmarks?
tumid - you get indurated plaques in sun exposed areas
panniculitis - infiltration and destruction of adipose tissue on the upper extremities
verrucuous - very thick, hyperkeratotic discoid-like lesions usually on extensor and sun exposed areas
What are some treatment options for SLE?
NSAIDS
Antimalarials
COrticosteroids
Immunosuppressants
What are some triggers for SLE?
sunlight
meds (antiseizure, ABx, BP)
What are some other non-specific skin lesions/symptoms of lupus?
telangiectasia, vasculitis, thrombophlebitis, raynaud’s, ulcers, gangrene, alopecia, urticaria, mucous membrane pigment changes, livedo reticularis
